Confirmation Of Request For Reasonable Accommodation (Page 2 of 4) in pdf

Confirmation Of Request For Reasonable Accommodation Page 2

DENIAL OF REASONABLE ACCOMMODATION REQUEST

(Must complete numbers 1-4; complete number 5, if applicable)

. Name of individual requesting reasonable accommodation:

Type(s) of reasonable accommodation requested: (Attach additional sheets if needed)

Request for reasonable accommodation denied because

(may check more than one box)

 Accommodation Ineffective

 Accommodation Would Cause Undue Hardship

 Medical Documentation Inadequate

 Accommodation Would Require Removal of an Essential Function

 Accommodation Would Require Lowering of Performance or Production Standard

 Other ( please identify)

Specific reason(s) for the denial of the requested reasonable accommodation (e.g

explain why accommodation is ineffective or causes undue hardship). Attached additional

sheets if necessary

If the individual proposed one type of reasonable accommodation which is being

denied, but rejected an offer of a different type of reasonable accommodation, explain both

the reasons for denial of the requested accommodation and why you believe the chosen

accommodation would be effective. Attached additional sheets if necessary.

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Confirmation Of Request For Reasonable Accommodation Page 2